Kirklees

Below is what happened to the kindest, most caring mum who had spent the last 30 years of her working life caring as an auxiliary on a geriatric day hospital ward, working in a system which eventually let her down so badly; exhausted all the fight from her tiny body and left family and friends grieving the loss of a wonderful mother, grandma, great grandma and auntie.

We are currently waiting for the Police investigation final report to be reviewed, praying that it will be sent to the CPS for criminal charges to be brought against those responsible. I feel Boris Johnson and his cabinet should also be added to the list as their rules in breach of human rights, meant that despite my efforts to protect her in her own home with no visitors except myself, adhering to protocols for PPE and infection control, and no hugs for over 1 year once my mum went into the “system” and under covid rules where I did not have access to her, it took 2 weeks for a care home to sentence her to death through their neglect. Had I ignored the covid rules as we know that our PM did, then I am sure she would have been alive today. I would not have allowed the neglect to take place and would have cared for her at home. The only time in two years I hugged my mum was as she lay dying in her hospital bed. I am beyond broken when I think about how my mum so desperate for a hug would tell me that “it was the rules” and held my dogs close while sobbing instead.

On 22nd February 2021 mum had a fall at home and after 3 hours an ambulance finally came and took her to our local hospital where she spent just over 2 weeks and was diagnosed with a fractured knee, a chest infection and also contracted a UTI while there. On 3rd March mum was assessed as medically fit to be discharged but because of the complexity of previous surgeries which had gone wrong, resulting in a loss of mobility I asked that she be assessed properly rather than just being shipped home, bed bound. After much debate and pleading for her not to be sent home which is something I now regret, a social worker found mum the only bed available in a care home at that time “requiring improvement” according to the CQC rating.

On the 13th of March 2021, mum was discharged medically fit into the care home on a discharge to assess bed to see what support she might need going forward into the care home I had found local to her friends and church. I spoke with her on her mobile every day, as did some of her friends, until Tuesday the 23rd of March when after 23 frantic calls to me asking me to get her out of there, the calls stopped, and her phone went dead.

On Friday the 26th of March following numerous phone calls to the care home over the last few days, I told them I was wanted access to my mum. It could no longer wait until the 14-day covid requirement. I had been unable to contact her social worker, or the care home manager, despite my repeated phone calls to both ASC team and the care home. I was ignored.

On my way to the care home, I received my first ever call from the care home manager to explain the process for my visit. I arrived at the care home, went down to have my covid test and went back to sit in the car. The window where the test took place was next to mum’s window so I could see in there when I arrived. I could see 3 people in her room tidying up food things off the cupboard top and window ledge and sorting out her bedding. I could see that at least one did not have any PPE on whatsoever. I assumed this was the care home manager as she was not dressed in any uniform. While sat in the car, I received a phone call from a guy who introduced himself as a GP. He informed me that he had just seen mum (virtually) and that she was very ill. He felt she was end of life and also mentioned sepsis. He said we had two choices, he could call an ambulance for her on 999 and get her into hospital or we could move her up to the third floor to the 24 hour nursing part of the home where she would be made comfortable and looked after. I said I couldn’t made that decision before seeing mum. As far I was aware from limited conversations with the care home, mum was dehydrated and had not been eating properly, he seemed shocked that I had not yet seen her and said he would call me back after my visit.

I now know that the GP was only called some 20 minutes after I told the care home that I was on my way in to see my mum. I was allowed into mum’s room with full PPE and a male care worker to be always with me. The sight of my mum in that stinking room will haunt me forever. She was laid in bed in a dirty nightdress with her head tilted to the side. She managed one word “hi”. Someone had put her glasses on for her…..they were her reading glasses and clearly she wasn’t in a state to be reading ! I asked why and the care worker did not know. I spoke to mum and told her she needed to drink (she’s dehydrated according to the care home). She understood me and was trying to drink what looked like cold tea from a closed toddler cup. When the care worker was giving it to her it was dribbling down right-hand side of her face and onto her nightie. Clearly that had happened a lot as it was wet through and stained brown.

Mum kept raising her hand to that bit and the care worker thought she was trying to wipe it off her face. I told him she annoyed she was wet round her neck on her nightie, he said he would change her when I had gone. I now know that he didn’t and she lay dying in filthy nightwear.

Mum looked to be in a bad way and had lost weight. I was distressed by the state of the room, the smell, the darkness, the shabby bare state. The bedding was stinking and had a fleece on top of a grey colour with wolves on or some other animal. The bed was an old-fashioned basic bed and certainly not a bed suitable for (as I now know), for someone with pressure sores.

I had to leave after half an hour and spent time talking with the senior on duty at the home (I never saw the manager), about what the doctor had said to me. She was aware of what he had said, and I told her my decision was going to be not to distress her any further by putting her through the ordeal of transfer to hospital. She agreed that was the best for mum and that she would move to the nursing floor. Thinking back on that afternoon, she knew what the GP had said and knew what the choices were. They had clearly discussed it before I went in to visit mum. I’m assuming this was while the video consultation had taken place when they were piecing together what story to tell now that the daughter had demanded access and wasn’t taking covid as an option to not.

Once sat back in the car, the GP called me again. We again talked about what was wrong with mum and he said he thought she was just giving up. He asked me if I thought she wanted to die……I told him no, she was a fighter and had fought for over 10 years with multiple operations. He talked about how they get confused and distressed and this sometimes happened. It would be kinder he said to let her go and be on the nursing floor where she would get 24 hour end of life care. I expressed my concerns that if there was something he had missed and we could have had her in hospital then I would never forgive myself. I was assured by him that it wasn’t that, it was just end of life and as she was so de hydrated. I agreed to let her go to the nursing floor. He said if I needed him I could call him anytime. I thanked him for his kindness. I have no words for what I think about this man who did not see my mother properly and condemned her to certain death in my opinion. Had he seen her in person, he would have surely known she wasn’t just dehydrated but as I now know, dying from pneumonia. Heartbreaking. He said he would arrange everything, the paperwork, the move, everything. I had no reason to doubt what he was saying. I think I am still in shock from this conversation. I knew mum was dehydrated and unwell but had never been told until today that it was so bad. WHY WHY WHY. To be asked to make these snap decisions was too much in this emotionally distressed state. I left the home believing mum was receiving immediate further required nursing in floor 3 and not in assessment room in the basement area where she had previously been.

Saturday 27th March. 7.15 a.m. After a sleepless night worrying about mum, I had a bad feeling about how my mum was and called the care home to see how she had been now that she was transferred to nursing. The staff member who answered the phone told me that my mum was not on the nursing floor. She knew that for sure as she was working on that floor as we spoke. She told me my mum was still downstairs on the D2A room. I said that mum should have been moved to that ward last night, but she didn’t know anything about it. I was so worried and asked to speak to the care home manager but was informed “she does not work the weekend”. I asked that she be contacted at home and was told “it was a bit early to call her”! I requested she did call her and was told she would. I expected a call back but didn’t get one.

7.30 a.m. I again called the care home and spoke with the senior I had spoken to the day before. I asked why mum was still on a D2A bed and she said because nothing had been agreed about mum moving to the nursing floor. I couldn’t understand why she was saying this as she was the very last person, I had seen on leaving the care home. I challenged her about it again and was eventually told that she had not been moved because that the paperwork needed to be done to make sure there was funding for the nursing bed. I was shocked beyond belief. I said it’s the weekend and when will this happen. She said she did not know, and she would have to speak to the manager. No call from the manager.

7.49 a.m. I again called the care home. I did not introduce myself and she did not ask who I was and I asked to speak to the senior. I was told that she was probably doing her rounds and that she would ask her to call me when she was done. How did she know who it was? Had they known it was me calling before (I assume so) and were fobbing me off or ignoring my calls. I asked her to dial 999 and get my mother an ambulance. She said she would.

8.32 a.m. Call from the care home informing me that an ambulance had been called for my mum but that it could take up to 2 hours for them to arrive. Massive relief that she was getting out of that hell hole and on her way to help. I asked if they had told them how poorly she was and was told “yes, I have told them she is dehydrated”. I asked to be called when the ambulance had taken her. This shocked me as only yesterday I was told she was approaching end of life, now no mention of anything to the emergency services apart from her being dehydrated. How can that be when yesterday she was so poorly as to need end of life 24-hour nursing care? I now know from records that the 999 call to the ambulance service only told them general decline and her daughter wants her in hospital. No mention of how poorly my mum was. The care home is some ten mins from the hospital, and I know that had they been aware of how poorly mum was, that they would not have taken almost 2 hours to attend. 10.08 a.m. Call from the care home informing me that mum was now in the ambulance and being taken to A & E.

About 11 a.m. I received a call from the A & E doctor at HRI to say they had mum with them and wanted background information. I explained what had happened and they were shocked. They said they were assessing her and would keep me informed. Shortly after the first call I received another from the same doctor asking me to repeat what I had said about the doctor doing a virtual assessment of mum. She said she had told her colleagues and they were so shocked they needed her to ring me back to check that’s what I had said.

I received a further call to say that mum had sepsis and was being transferred to the frailty ward and that the doctors had triggered safeguarding concerns over both the care home and the doctor. I was told that mum had pressure sores, something I knew nothing about prior to this conversation. Mum was being transferred to the frailty ward.

I received a call from the sister on the ward telling me how poorly mum was and asking if I would like to come in and see her, which I did. I went to see mum on Saturday teatime and was told they were going to try her with an IV for fluids and antibiotics. I didn’t see any fluids or antibiotics being given via IV but did see a canula in her left arm. I took a pictures of mum and her nails which appeared to have black muck underneath them. How could her nails get so dirty when she had been immobile? What was under her nails? On the Saturday night the doctor came to talk to me. He said they had tried antibiotics and mum wasn’t responding and that her vital organs were shutting down. He said if it was someone my age they would use intensive care, but that it was kinder just to make mum comfortable (I keep hearing this and am now wondering if they gave up on her too soon).

Mums pressure sores were treated continuously, and she was on an air bed. Without exception, all of the staff who spoke to me said that this should never have happened and that the pressure sores were neglect. Some of the staff had seen her just two weeks prior when she was discharged, and they couldn’t understand why she was in this state. Mum was made comfortable and not given any further food or water. For 4 days, the hospital allowed me to sit with her almost 24 hours, where I stroked her head and hands, talked to her and played her favourite music. Mum passed away with me holding her hand at 9.30 pm on the 1st April. I was devastated.

Sitting by my mum’s bedside watching her die has to be the most harrowing thing I have ever done in my lifetime. To be speaking to my mum on the Tuesday to then hear she is end of life on the Friday, without a doctor actually physically seeing her is beyond all belief. Mum did not see a doctor from the day she entered the care home until a facetime call by a GP 20 minutes after I told them I was going in regardless at which time he diagnosed her end of life.

Watching my mum turn to a bag of bones and clearly try to communicate with me will haunt me forever. I pray those who failed her are brought to justice. This was not an elderly person just giving up, this was my mum neglected so badly that she died from that neglect. Pneumonia is what killed my mum, but the care home, social worker, GP and even the hospital staff have to take responsibility for neglecting and failing her just as the system has done for over 12 years now, which I begged in my 8 page overview document given to all agencies when she went into the care home, not to let happen.

A forensic autopsy was carried out on my mum which confirms cause of death to be broncho pneumonia. The Police investigation has been submitted for review and once this is completed the decision as to whether there is a criminal case to answer will be taken. The inquest has been adjourned twice now pending the final police report but provisionally set for October this year. I have seen the coroners report and a copy of the statement given by the GP which is full of lies, covering his back and attempting to cover the care home. I have told the coroner and the GP will now be called to give evidence as opposed to just getting away with a statement full of lies.

My mum should have been assessed in that home, gone into a lovely home local to us who were awaiting the outcome of her assessment, and spent the last however many years of her life being cared for, visited by her friends from church and family. Instead behind the cover of Covid my mum was sentenced to death by poor care, lack of experience, poor practice, acts of omission and downright neglect, all of which were carried out by people I and the rest of the family trusted to care for her. I pray that those responsible do not get away with it. It was all avoidable.

I could talk forever about Mum and how she was my absolute best friend and how her not being here leaves a huge hole in our lives. My mum tried to tell me that things were not right in the Care Home, and because of Covid and my need to keep her safe, I didn’t listen. I will regret telling her that that she would be OK, not demanding to see her sooner and believing that the system would keep her safe. Mum went into the care home the day before Mothers day and on mothers day I took her presents, cards and photos which had all prepared to let her know how much we loved her. I took our dogs, lifting them up to the window which made her smile and spoke with mum through the window. I now know that the staff did not pass on her mothers day cards and gifts, instead leaving them in a corner out of reach and without mention. How alone and abandoned must she have felt.

On a final note, I will tell you what the CQC have done in all of this. Following the hospitals triggering of safeguarding, the police visit to the home, they visited and inspected the premises and despite noting on their published report (which I had to find out from the internet), that a resident had died following being in that care home, they upgraded it from “requiring improvement”, to “good”. The care home manager was replaced almost immediately.

If one more person mentions “lessons learnt”, I swear I will scream and won’t be able to stop.

I believe that the system is set up to be so complex that we will go away. I’m going nowhere until I get answers and justice for my mum and all the thousands of vulnerable members of our society who suffer neglect in our broken system.